NEUFLEX MCP/PIP FINGER JOINT IMPLANT SYSTEMS SURGICAL TECHNIQUE. This publication is not intended for distribution in the USA.

Transcription

1 NEUFLEX MCP/PIP FINGER JOINT IMPLANT SYSTEMS This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE

2 MCP SURGICAL TECHNIQUE Summary provided by designing surgeon Arnold-Peter C. Weiss, MD, Providence, R.I. Expose the metacarpal joint using bilongitudinal skin incisions or a single transverse incision across the metacarpal heads. Note: This technique will focus on the bilongitudinal skin incision. Step 1 Make one 5 cm longitudinal incision between the index and middle finger metacarpal heads and one between the ring and small finger metacarpal heads. This incision will allow access to two adjacent MCP joints. Perform subcutaneous dissection to the extensor hood. Incise the ulnar sagittal band and extensor hood longitudinally, with the entire extensor tendon reflected radially. Next, excise inflammatory synovium with a rongeur. Step 2 Resect the metacarpal head at the distal end of the metacarpal metaphyseal flare, using a micro-oscillating saw in a plane perpendicular to the long axis of the metacarpal shaft. Generally, resection of the base of the proximal phalanx is not required. Using rongeurs, remove any sharp osteophytes or spurs from the joint. Step 3 To establish starting alignment for subsequent broaching, introduce the rasp/awl combination instrument in the metacarpal shaft and proximal phalanx. 2 DePuy Synthes NEUFLEX MCP/PIP Joint Implants Surgical Technique

3 Step 4 Beginning with the smallest broach, prepare the metacarpal canal to the largest size acceptable to allow full seating of the broach to the stop flange. To avoid rotation during broaching, use an advancing-retracting rasping method. Step 5 Use the trial implant corresponding to the smaller of the fully seated and maximized broaches (either proximal or distal) with smooth forceps. Insert the larger metacarpal stem first. Follow by inserting the distal stem with the finger flexed to aid with final seating. Check the range of motion and alignment of the MCP arthroplasty. Insert the final implant after size evaluation. Step 6 Use one or two horizontal mattress sutures tensioned to have the extensor tendon positioned directly over the midline of the dorsal portion of the metacarpophalangeal joint. Imbricate the radial hood and sagittal band. Range the joint again to ensure there is no subluxation of the extensor tendon from 0 to 90 degrees of flexion. Irrigate the wounds with the skin closed over a thin silicone drain. Postoperative Care After all four MCP arthroplasties have been performed, place a bulky-fluff dressing with a volar splint, maintaining the four fingers in approximate longitudinal alignment and full extension. Leave the splint in place for five to eight days, prior to beginning early therapeutic range of motion and splinting. NEUFLEX MCP/PIP Joint Implants Surgical Technique DePuy Synthes 1

4 PIP SURGICAL TECHNIQUE Summary provided by designing surgeon Arnold-Peter C. Weiss, MD, Providence, R.I. Step 1 Make a gradual curving dorsal incision over the PIP joint. Carry dissection down to the extensor tendon mechanism. Gently elevate skin flaps by careful dissection to expose an appropriate portion of the extensor tendon mechanism. Make an incision between the central tendon of the extensor tendon mechanism and the lateral band on one side of the digit using a #15 blade. Occasionally, an incision needs to be made between the central tendon and the lateral band on the opposite side of the digit. However, this is not always the case. Step 2 Incise the dorsal capsule longitudinally to expose the dorsal PIP joint. Some recession of the dorsal portion of the collateral ligaments may be required to allow appropriate exposure of the proximal interphalangeal joint. Step 3 While protecting the central tendon using retractors, use a micro-oscillating saw to resect the proximal phalanx head at the metaphyseal flare. Use a rongeur to remove spurs from the base of the middle phalanx. 2 DePuy Synthes NEUFLEX MCP/PIP Joint Implants Surgical Technique

5 Step 4 Use the rasp/awl combination instrument to begin opening canals in both the proximal and middle phalanges. Step 5 Use sequentially sized broaches to form both the middle and proximal phalanx up to a maximum size that will seat the broach completely. Step 6 Use trial implants to size and ensure appropriate stability after implantation. The trial implant should sit flush against the middle and proximal phalanx and be relatively stable. Occasionally, in order to gain enough exposure in difficult cases, the collateral ligament on one side needs to be released from the proximal phalanx to allow exposure. If this is required, repair the collateral ligament using monofilament nonabsorbable #4-0 sutures through drill holes in the proximal phalanx after the implant has been placed. If necessary, repair the capsule and the extensor mechanism, with nonabsorbable #4-0 multifilament sutures. Place a drain and close the skin with a conforming dressing, maintaining the PIP joint in a very slight flexion of 10 to 20 degrees. Postoperative Care Guarded active flexion/extension exercises can commence several days after the procedure, ensuring that any repaired collateral ligaments are protected from deviating forces for at least four to six weeks. Alternatively, the finger can be splinted in a resting position for up to three to four weeks after which range of motion exercises can begin. NEUFLEX MCP/PIP Joint Implants Surgical Technique DePuy Synthes 3

6 INSTRUMENTS The NEUFLEX instruments feature: Ergonomically designed handles for surgical ease of use. Color-coded proximal and distal broaches and trials for quick identification. A single, lightweight instrument sterilization case houses the instruments and is color-coded for ease of use. A utility bin area is included to house ancillary instruments. Dual action tooth pattern with a stop flange on the broaches, designed to match the size of the corresponding colored trials and implant stems, allows for cutting and removal of bone in one easy step. A complete range of trial sizes from 0-60 (MCP) and 1-5 (PIP) to meet most patient s needs. MCP PIP 4 DePuy Synthes NEUFLEX MCP/PIP Joint Implants Surgical Technique

7 ORDERING INFORMATION MCP Implants PIP Implants Cat. No. Size MCP Instruments Cat. No. Size MCP Instruments Cat. No. Size/Colour Cat. No. Size/Type Trials Broaches Pink Proximal Distal Yellow Proximal Distal Orange Proximal Distal Red Proximal Distal Blue Proximal Distal Green Proximal Distal Black Proximal Distal Cat. No. Description Instruments Rasp/Awl Instrument Tray Cat. No. Size/Colour Cat. No. Size/Type Trials Broaches Blue Proximal Distal Teale Proximal Distal Yellow Proximal Distal Purple Proximal Distal Olive Proximal Distal Cat. No. Description Instruments Rasp/Awl Instrument Tray NEUFLEX MCP/PIP Joint Implants Surgical Technique DePuy Synthes 5

8 Johnson & Johnson Medical Limited PO BOX 1988, Simpson Parkway, Livingston, West Lothian, EH54 0AB, United Kingdom. Incorporated and registered in Scotland under company number SC DePuy Orthopaedics, Inc. 700 Orthopaedic Drive Warsaw, IN USA Tel: +1 (800) Fax: +1 (574) DePuy International Ltd St Anthony s Road Leeds LS11 8DT England Tel: +44 (0) Fax: +44 (0) DePuy (Ireland) Loughbeg Ringaskiddy Co. Cork Ireland Tel: Fax: depuysynthes.com Johnson & Johnson Medical Limited All rights reserved. CA#DSEM/JRC/0315/0263 Issued: 03/15